Obstructive vs. Restrictive lung disease Flashcards
obstructive is characterized by?
- airflow obstruction
- increased airway resistance
- often affects expiratory flow rate
restrictive lung disease is characterized by?
- reduced lung compliance
- reduced thoracic compliance
- often affects inspiratory volume
obstructive lung disease (OLD) includes:
- chronic bronchitis
- emphysema
- bronchiectasis
- asthma (also restrictive)
- CF
Restrictive lung disease
- interstitial lung disease
- idiopathic pulmonary fibrosis (IPF)
OLD - epidemiology
3rd leading cause of death in US
- smoking is primary risk factor
- 11th year demonstrating more women die from diagnosis of COPD than men
OLD radiographs
- flattened diaphragm
- hyperinflated lungs due to air trapping
- enlarged heart with enlarged right ventricle
- barrel chest
OLD potential consequences
- destruction of lung tissue resulting in emphysema
- inflammation of airways
- hypoxemia
- dysrhythmias
- sleep disorders
- repeated infections
- build up of secretions
OLD consequences continued
polycythemia
- adaptation to chronically low 02 - be careful giving more 02 –> reduces hypoxic drive to breathe
- sluggish blood flow
- right side heart failure
- resistance to air flow -> inc. work of breathing
- normal or increased lung capacity
Chronic bronchitis:
Diagnosis and causes
Greater than 3 months of productive cough most days in at least 2 consecutive years
causes:
- irritation of bronchial tree (smoke, particles)
- genetics
- respiratory infections
symptoms of OLD
- secretion production
- reduced cilia action leading to build up of secretions and bacteria
- repeated infection, pneumonia
- hypoxemia
Emphysema- End stage COPD
Definition and actions
Abnormal, permanent increased size of air sacs distal to terminal bronchioles by destruction of alveolar walls
- alveolar destruction
- over inflation of lungs, cannot empty
- emphysematous bull
- chronic hypoxia and hypercapnia (excessive CO2) in blood
Restrictive lung disease (RLD) includes?
decreased expansion of lungs
- decreased total lung capacity
- hypoxemia
Examples of RLD
- disease of pleura
- disease of chest wall (kyphoscoliosis, obesity)
- extrapulmonary mass restricting expansion of lungs
causes of RLD?
- stiffening of lung tissue preventing expansion
- structural limitations preventing lung inflation (kyphoscoliosis)
- interstitial lung disease
- pleural abnormalities “trapped lung”
- mass
- lupus
- pmneumothorax
- connective tissue disease: scleroderma
- radiation therapy
- idiopathic pulmonary fibrosis (IPF)
Idiopathic pulmonary fibrosis
onset: middle age (50-70)
- 4-5 yrs life expectancy
- increased respiratory rate (30-40)
- hypoxemia, cyanosis –> give 02
- treat inflammation before it turns into fibrosis (corticosteroids)
Medical treatments for lung diseases?
- steroids: for inflammation
- antibiotics: for infections
- 02: to treat hypoxemia
- inhalers: for bronchospasm
- assisted ventilation: invasive or non
- lung transplant
- lung reduction surgery
Pulmonary function tests
- obstructive
- restrictive
- low FEV1, normal vital capacity
2. FEV1 normal, low vital capacity
Blood gases normal values
- Pa02: 85-100mmHg
- PaCO2 35-45 mmHg
- pH 7.35-7.45
- SaO2 95-100
PT assessment for lung disease includes?
- 02 needed at least and for activity
- blood gases
- auscultation
- RR, breathing patterns
- endurance
- perceived exertion
- time to return to baseline HR & RR
- Sa02
- gait safety
- education needs
- lifestyle changes
Precautions?
- pt may have chronic hypoxemia –> certain level of hypoxemia required to inspiration. Over oxygenating these patients may decrease inspiratory drive
- target Sa02 is lower: 88-92
- time to return to steady state may be prolonged
- few or now symptoms at low Sa02
- low Sa02 will overtax heart and results in cell death, actual death
Alert???
- ILD and 02 desaturation
- Monitor with pulse oximeter from start if you have pt with ILD
- be prepared to see 02 saturation drop with minimal activity
- always have full 02 tank
PT treatments
- breathing control
- pacing skills/work simplification
- endurance training
- strengthening
- education - 02 management, fatigue scale
- confidence building
Goal setting examples
- pt. will complete supine to sit with minimal resistance of 1 person with RPE88, with contact guar of 1 person in 4 weeks
- pt will tolerate 20 consecutive min of activity at RPE 6-8 independently within 4 weeks
